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Flashcards in other Deck (113):
1

ependymoma - histology

1. perivascular rosettes
2. rob-shaped blepharoblasts (basal ciliary bodies) found near nucleus

2

Migraine treatment

acute: NSAID, triptan, ergot
prophylaxis: topiramate, verapamil, life style, propranolol, amitriptuline, valproate

3

Multple scleoris - CSF

increased IgG + myelin basic protein

4

Limbic system - structures

1. hippocampus
2. amygdala
3. formix
4. mammilary bodies
5. cingulate gyris

5

extra-ocular movements during REM are due to

Paramedian pontine reticular formation/conjugate gaze center

6

Cerebellum deep nuclei

lateral to medial
Dentate, emboliform, globuse, fastigial

7

cns watershed zone damage -->

1. upper leg/upper arm weakness
2. defect in higher order visual process

8

causes of anencephaly

1. low follate
2. DM1

9

Freidreich ataxia - mode of inheritance

AR (GAA on frataxin / ch 9)

10

penis dermotome

S3

11

local anesthesia - order sensation loss

1. Pain
2. Q
3. Touch
4. pressure

12

cyclobenzaprine - mechanism of action

centrally acting skeletal relaxant (related to TCA)

13

MERRE syndrome - meaning and manifestations

myoclonic epilepsy, ragged red fibers
--> progressive myocl epilepsy
--> short stature
--> lactic acidosis
--> hearing loss

14

pseudorosetes rosetes are aka

Horner Wright

15

Collier sign

parinaud syndrome --> bilateral eyelid retraction --> sclera visible aboce the superior corneal limbs

16

hydrocephalus caused by increased CSF production is due to

papillomas of the choroid plexus

17

Vernet syndrome

lesion of jugular foramen synftome --> dusfunction of CN IX, X, XI

18

chemoreceptor zone - location

in the area postrema of the dorsal medulla near the 4th ventricle

19

horizontal gaze center - location / aka

aka: doll's reflex
midbrain

20

MC location of sacculat aneurysm

anterior commun + ACA

21

Nucleus basalis of Meynert - location

neocortex

22

anterior 2/3 of the tongue is separated by 1/3 by

ternimal sulcus (and foramen cecum in the middle)

23

the spinal accessory nerve is vulnerable to injury at

the posterior triangle of the neck

24

bilateal ACA occlusion

1. behavioral problems (abulia)
2. urinary incontinence
3. primitive reflexes

25

intraventricular hemorrhage in preterm infants originates from the

germinal matrix, a highly cellular + vascularized layer in the subventricular zone from which neurons + glial cells migrates out during bran development

26

posterior limb of of the internal capsule carries

anterior 2/3 --> motor fibers
posterior 1/3 sensory fibers
most lesions result in pure motor or combines (rare pure sensor)

27

visual cortex lesion - macula sparing - why

because macula receive collateral blood flow from MCA

28

Cavenous sinus thromobisis - due to

mc is due to contiguous spread of an infection from medial 1/3 of the face, sinuses (ethmoidal, sphenoidal), or teeth --> infection goes retrograde (valveless facial venous systme) via superior + inferior opthalmic veins
MC: s. aureus

29

CNS - histamine is produced at ... / role

posterior hypthalamus --> play important role in arousal + weakness

30

corpus collosum blood supply

anterior 4/5 --> ACA
splenium --> PCA

31

permeability barrier in nervous system

perineurium

32

lateral cerebellar hemisphere is aka

neocerebellum or cerebrocelebellum

33

prosopoagnosia - area of lesion

right inferior temporal lobe (vascular teritorry of the the MCA

34

endotracheal intubation in a patient with chronic RA -->

sublxation (vertebral malalignment) the atlantoaxial joint --> acute compression of the spinal cord / vert arteries --> spinal shock (paralyisis, decreased reflex below the level of compression), hypotension (due to loss of sympathetic tone, sudden death

35

glossopharyngeal nerve - parasympathetics

inferior salivatory nulcleus --> CN 9 --> otic ganglion --> travels allong auticulotemporal nerve (V) parotid gland secretion

36

arcuate nuclei of hypothalamus

secretion of dopamine (inhibits prolactin), GHRH, GnRH

37

thoracic outlet syndrome is due to compression of ..... in the

lower trunk of plexus + subclavian vessels in the scalene triangle (between anterior + mimiddle scalene muscles + the 1st rib)

38

interscalene nerve blcok --> side effects

transient ipsilateral dipragmativ paralysis due to involvment of phrenic nerve roots as they pass thorought the interscalene sheath
(should be avoided in COPD or contralateral phrenic nerve lesion)

39

1. CN 9. 10, 11 exit the brainstem through
2. CN 12 exits the brainstem through
3. CN 3 exits the brainstem through

1. postolivary sulcus (posterior to olive)
2. sulcus between olive + pyramide
3. interpendicular space

40

patients with temporomandibular disorder due to V3 can have -->

boh jaw + otologic symptoms

41

infraorbital nerve is the continuation of the

maxillary nerve (V2)

42

binocular visual field - in degrees

bnocular field - 120
monocular field - 40 in each eye
all: 200

43

orbital floor damage -->

- sensation of upper cheek, upper lip, upper gingiva numbness + paresthesia (infraorbital nerve)
- exopthallmos (etrapment of the inferior rectus muscle) --> impaired vertical gaze

44

optic track lesions - Marcus Gunn pupil

optic tract lesions can also cause relative afferent pupillary defect in the pupil contralateral to the tract lesion, as the nasal portion of the retina contributes more inputo to pretectal nucleus than the temporal lesions

45

trapezius paralysis -->

1. drooping of shoulder
2. impaired abduction above horizontal
3. winging scapula

46

general features that aid in localizing a transverse spinal cord section

1. moving rostrally --> increased amount of white matter, decreased gray, more oval
2. lower cervical + limbosacral regions have large ventral horns
3. thoracic + early lumbar have intermediolateral cel columns
4. gracile + uneate fasciculi are present above T7 spinal levels, hhere only gracili fasciculis below this level

47

CN 7 exits the skull through .... and ....

stylomastoid foramen --> course within parotid gland --> terminal 5 branches:
1. temporal
2. zygomatic
3. buccal
4. mandibular
5. cervical

48

cerebellum area that control balance + eye movemets

flocculonodular

49

radial nerve enter forearm anterior to lateral epicondyle - after?

divides into
superficial--> somatic sensory innervation to the radial half of the dorsal hand
deep --> innervates the extensor muscles of forerm

50

radial nerve trauma in the supinator trauma

due to repetitive pronation/sunipation of forearm (screwdriver), dirct, dislocation of radius --> finger drop, not wrist drop, and not sensory symptoms
(between superficial + deep parts of supinator muscle

51

locus ceruleus

paired of PIGMENTED brainstem nucleus --> located in the posterior rostral pons near the lateral floor of the 4th ventricle + functions as the principal site for norepinephrine syntheisis --> projects to all parts of CNS --> control mood, arousal (reticular activating system), sleep-wake states, cognition, autonomic function
implicated in the pathogenesis of anxiety disorders

52

the CN 3 arises (level)

rostral midbrain at the level of superior colliculis + red nucleus, exits at the interpenducular fossa

53

the CN 4 arises (level)

caudal midbrain + exits the dorsal midbrain just below the inferior colliculis) --> decussates

54

facial nucleus is located

in the dorsalateral aspect of the caudal pon and extis at the ventrolateral pontomedullary junction (below the middle cerebellar peduncles

55

primary visual cortex is aka ... / divided to

striate cortex. Divided to:
1. cuneus gyrus --> upper retina/lower field
2. lingual gyrus --> lower retina/upper visual field

56

Optic tract fibers project mainly to the

1. lateral geniculate nucleus
2. superior colliculus (reflex gaze)
3. pretectal area (light reflex)
4. surachiasmatic nucleus (cyrcadian rhythms)

57

causes of CN 7 trauma

fractures of temporal bone after lateral head trauma or zygomatic orbit fractures

58

2 mc symptoms of PCA stroke

1. contralateral hemianopia with macular sparing
2. paresthesia + numbness on face, trank + limbs (lateral thalamu)

59

anterior choroidal artery

last branch of internal carotid --> posterior limb of internal capsule, optic tract, lateral geniculate body, choroid plexus, uncus, hippocampus, amygdala

60

artery of Percheron

branches off either the right or left PCA and supplies the bilateral thalami + dorsal midbrain
it is a rare normal variant and consider in patients bilateral thalami or dorsal midbrain strokes

61

muscle spindle system vs Golgi tendon system

spindle --> monitors + maintains muscle length (intrafusal muscle fibers connected in paraller)
Golgi --> monitors + maintains muscle force (in series arrangement) --> ib sensory axons from here contact inhibitory interneurons

62

from carotid sinus to medullary center

CN 9 --> Hering nerve (a branch of CN 9)

63

direct vs inderect sympathomimetics according to CNS

indirect enter more readily

64

blood solubility of an anesthetic is indicated by

its blood/gas partition coefficient:
higher blood solubility --> larger coefficient --> dissolve more easily in the blood --> larger amounts must be absorbed before becomes saturated --> slower induction
--> if lower coefficient (eg. N20) --> rapidly saturated

65

Caspaicin?

used topical --> loss of membrane potential in noniceptive fibers + depletion of Sub P --> initial application results in burning + stinging sensation --> chronic exposure leads to reduced pain + transmission
(FOUND IN CHILLI PEPPER FAMILY)

66

Drugs for neuropathic pain

1. tricyclic antidepressants
2. Anticonvulsants
3. opioids
4. Caspaicin
5. Lidocaine

67

side effects of levodopa that persist after carvidopa administration

behavioral symptoms (eg. anxiety + agitation) --> more with carvedipa --> decrease the dose --> if not possibl, add atypical antipsychotics (such as clozapine)

68

fever above 42.2 -->

oxidative phosphorylation ceases --> ATP depleted -> end-organ damage

69

Heat stroke - everything

caused by environmental exposure (eg. children left in hot cars --> requires treatment with active cooling

70

febrile seizures - active cooling?

have not been shown to reduce the risk of seizres and may induce seizures by shivering + a transient rise in core body Q

71

phenytoin causes gingival hyperplasia - mechanism

phenytoin --> increased PDGF --> macrophages activation --> stimulate proliferation of gingival cells

72

juvenile myoclonic epilepsy?

a form of idiopathic generilized epilepsy that may be familial --> both arms are typically affected (both cerebra hemispheres are involved) --> sympotms espc by sleep deprivation + 1st h after awaking
treatment: broad spectrum anticonvulsant (like valproic)

73

Ramelteon?

Ramelteon?melatonin agonists --> safe + effective in reducing time to sleep onset in elderly (benzodiaz, antihistamines, sedating antidepressants should be avoided in elderly)

74

halothane mediated hepatitis - biopsy

centrilobular hepatic necrosis

75

CN V neuralgia - location / treatment

particulary V2/3
carbamazepine is 1st choice (2nd: baclofen + valproic)

76

opiodis induces euphoria / mood alternations - mechanism

involve dopaminergic pathways in the nucleus accumbens

77

antiemetic drugs

1. antimuscarinics (scopolamine) --> motion sickness
2. antihistamines --> motion sickness
3. Dopamine antagonists (metoclopraminde, prochloroperazine --> chemo
4. 5-HT3 inhibitors --> chemo
5. Neurokinin receptor antagnosits --> inhibits Substance P (Aprepitant, fosaprepitant) --> chemo

78

train-of-4 stimulation

used during anesthesia to assess the degree of paralysis induced by NMJ agents --> peripheral nerve is stimulated 4 times in quick succession and the muscular response is recorded:
1. nondepolarizing blocker --> progressive reduction of each of the 4 responses (fading pattern) as a result of less ach being releasd in each subsequent impulse due to the additional effect of presynaptic ach receptor blockage)
2. depolarizing blocker --> initially equal reduction of all 4 twitches. Persisten exposure (phase 2) like nondepolarizing

79

bupropion is preferred compare other antidepressants because

1. no sexual dysfunction
2. less weight gain

80

1. smoking cessation drug that reduce craving + attenuate rewarding effect of nicotine
2. alcohol cessation drug that reduce craving + attenuate rewarding effect of nicotine

1. varenicline
2. naltrexone

81

1st generation antipsychoticis: low vs high portency according to side effect

low (chlorpromazine, tioridazone) --> anti-hist, chol, a1
high potenecy --> neurologic (eg. extrapyramidal)

82

paradox antipsychotics mediated akathisia

frequently misdiagnosed becaue misinterpreted as worsening psychotic symptom --> increased dose rather than decrease --> exacerbation of akathesia

83

Neonatal abstinence syndrome

Withrawal from transplacental OPIATES due to maternal use --> neurologic, GI, autonomic symptoms

84

opioid receptors - effects

Mu: Physical dependence, Euphoria, Resp + cardiac depress, reduced GI motility, sedation, analgesia
Kappa: Miosis, dysphoria, sedation, analgesia
Delta: antidepressants analgesia
(ALL at MU except miosis (k) and antidepressant (delta))
ALL ARE ANALGESIC

85

CNS lymphomas - chemotherapy

poor respond

86

carvenous hemangioma --> increased risk for

1. intracarebral hemorrhage
2. seizure

87

another clue for VHL

congenital cysts and/pr neoplasms in the kidney, liver, pancreas

88

Guillain-Barre syndrome - cranial nerves?

Bell palsy

89

Micturation reflex (urination) is regulated by the following ceters

1. Sacral micturation center (S2-4): bladder contraction (parasympath)
2. Pontine mictiration center: ponitne reticular foramtion --> coordinated relaxation of ecternal urethral sphincter
3. cerebral cortex - inhibits sacral micturation center

90

Amyloid precursors protein - function

transmembrane protein (found throughout the body)

91

acute cerebellitis

post-viral cerebellar ataxia --> in children --> 2-3 weeks aftere varicella, measles or RBV infection -> resolve in 3 weeks

92

the special charactersitic of C1 spinal nerve

the only spinal nerve carries only motor fibers

93

Lissencephaly?

aka: agyria --> congnital absence of gyri --> severe mental retardation + seizures

94

decerebrate vs decorticate

decerebrate --> damage to brainstem at or BELOW red nucleus (midpbrain tegmentum, pons) --> extensor posturing due to loss of descending excitation of the UPPER flexors
decorticate --> damage above red nucleus (hemisph, internal capsule) --> flexor due to loss of descending inhibition of the red nucleus --> hyperactivity of upper flexors

95

neurons are highly sensitive to iscemia - mechanism

they do not store glycogen

96

Prgressive supranuclear palsy

form of parkinsonisn resulting from neurodegeneration of the midbrain and frontal subcortical white matter --> rapidly progressive gait dysfunction and falls, exetutive function loss, and vertical gaze palsy
biopsy: deposition of phosphorylated tau proteins

97

MS - hot shower

exacerbate fatigue due to decreased axonal transmission associated with increased heat

98

tetanus toxin - detection

there is no available assay to detect it.
THE DIAGNOSIS OF TETANUS IS CLINICAL

99

osmotic demyelination - manifestation

1. quadriplegia due to demyelination of corticospinal tracts
2. pseudobulbar palsy due to demyelination of the corticobulbar tracts of CN 9, 10, 11

100

vascular vs Alzheimer dementia according to manifestation

vascular is more acute

101

Red nucleus - location / function

located at anterior midbrain. Participate in motor coordination of the upper extremities

102

raphe nucleus - location and function

located in the brainstem
role in sleep-wake cycle, anxiety, mood, psychosis, sexuality, eating behavior, impulsivity

103

hypocretin functiuon

promote wakefulness + inhibit REM sleep-related phenomena

104

Stages of grief - terminal illness

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

105

adolescents are less less able to wiegh the risks and benefits of their decisions or anticipate that negative consequences may occur - mechanism

prefrontal cortex (center of executive function ) does not fully develop until 3rd decade of life

106

first symptom of alcohol withdrawal

tremulousness

107

Medical conditions linked to premature ejaculation

1. prostatits
2. thyroid disease

108

frontal lobe lesions

executive dysfunction + personality changes 2ry to impairment of the organisational, restrain + motivational systems:
left side --> apathy + depression
right side --> disinhibition

109

Dmage to corpus callosum

split brain damage --> lack of interhemispheric transfer of informations (eg. unable to retrieve by one hand an object palpated with the other)

110

dominant temporal lobe lesion

dominant: verbal memory (world recognition)
nondominant: nonvebral memory, including musical ability

111

methadone adverse effect

1. long QT
2. Resp depression

112

Schwannoma histology

- Antoni A: spindle cells + palisading nuclei surrounding pink areas (+verocey bodies: interspersing nuclear free zones)
- Antoni B: looser stroma, fewer cells, and myxoid change
- S100

113

cricothryrotomy - passes through

skin --> superficial cervical facia (including fat + platyasma) --> investing and pretracheal layers of the deep cervical fascia --> cricothyroid membrane
(the 3rd layer of deep cerical fascia, the prevertebral, is not penetrated)